The Department of Health and Human Services (HHS) said its final rule on employment-based wellness programs, released yesterday, supports workplace health promotion and prevention as a means to reduce the burden of chronic illness, to improve health, and to limit growth of health care costs, all while ensuring that individuals "are protected from unfair underwriting practices that could otherwise reduce benefits based on health status."
The final rule continues to support "participatory wellness programs," which generally are available without regard to an individual’s health status. These programs reimburse or reward employees for such initiatives as joining a fitness center, attending health education seminars, or completing a health risk assessment with no obligation to take further action.
The rules also outline standards for nondiscriminatory "health-contingent wellness programs." These generally reward individuals who meet a specific standard related to their health; for example, quitting or cutting down on tobacco use; achieving a specified cholesterol level, weight, or body mass index; or, if the individual fails to meet these goals, taking certain other healthy actions.
The maximum reward that employers may offer employees under appropriately designed wellness programs is 30% of the total cost of employee-only coverage under the plan, except for tobacco-use program rewards, which max out at 50%. The final rule also requires that health-contingent wellness programs be reasonably designed, be uniformly available to all similarly situated individuals, and accommodate recommendations made at any time by an individual’s physician based on medical appropriateness.
The final rule, issued jointly by HHS, the Internal Revenue Service, and the Department of Labor, will be effective for plan years beginning on or after Jan. 1, 2014.
Meanwhile, a recent Wall Street Journal article reported that nearly 90% of employers offer incentives, financial rewards, or prizes to employees who work toward specified wellness goals, up from 57% in 2009. The article continues with pros and cons of popular types of programs.
New companies have signed on to participate in next week's Virtual Career Fair. This free online event, exclusively for APTA members, happens on Thursday, June 6, 1:00 pm-4:00 pm ET. At no charge or obligation, members can engage directly with employers about their current and future physical therapy opportunities. Participate in the Virtual Career Fair for as long as you wish and with as many different potential employers as you wish, chatting 1-on-1 with recruiters to discuss your background and experience, and their current and future career opportunities. The new participants are Beatrice State Developmental Center, Concentra, and Precision Physical Therapy.
Limited space is still available, so register today.
Unlike paper medical records that Hurricane Katrina soaked and batted about in the Gulf Coast winds in 2005, electronic health records (EHR) from the Oklahoma City area remained intact and available throughout most of the recent tornado that struck the suburb of Moore, reported ModernHealthcare.com.
Oklahoma's Secure Medical Records Transfer Network (SMRTnet) stores records for more than 2 million people and connects 90% of the hospital beds in the area, and while communication between SMRTnet and Norman Regional Health System (NRHS) was down for 7 hours at one point, it remained open to other networked hospitals. Many patients from Moore Medical Center had been evacuated to the Norman Regional Hospital and HealthPlex about 10 miles away; both are part of NRHS.
Despite the diffusion of Moore patients from their local facility to places across the metro area, spokespeople for the hospital systems said they were able to get needed information to providers via SMRTnet.
Read the 2012 Annual Report to see the American Physical Therapy Association's year in review, including progress on the association's strategic plan; reports from the president, House of Delegates, components, and treasurer; membership stats; and financial status. The annual report is in a downloadable, interactive PDF format.
If you're a mom with your doctor of physical therapy degree, Family Circle magazine may be interested in having a reporter interview you for an upcoming story, "Best Advice from Dr Mom." The story focuses on what these moms do to keep their families happy and healthy. Family Circle is looking for someone with a child or children between the ages of 7 to 18, affiliated with a university, and located in the Midwest, West, or Northwest. If you're interested and available, please contact APTA's Jennifer Rondon no later than Tuesday, May 28.
Federal legislation proposed this week would help advance rehabilitation research within the National Institutes of Health (NIH). Bill S 1027, introduced by Sens Mark Kirk (R-IL) and Tim Johnson (D-SD), calls for a working group comprising various NIH institutes and centers to update and streamline NIH's rehabilitation research priorities.
The bill would require a report on the feasibility of implementing recommendations proposed in the final report of the NIH Blue Ribbon Panel on Medical Rehabilitation Research, which included APTA members Rebecca Craik, PT, PhD, Anthony Delitto, PT, PhD, and Alan M. Jette, PT, PhD. It also would allow interagency agreements to better coordinate rehabilitation research conducted by agencies outside of the Department of Health and Human Services.
Shortly after the release of the Blue Ribbon Panel recommendations late last year, APTA's Section on Research spoke with Kirk's office about the recommendations as part of APTA's 2013 research fly-in. During the fly-in, leading physical therapy researchers from Illinois and across the country highlighted the positive contributions of rehabilitation research and advocated for advancing the role of this research at NIH.
APTA applauds this legislation and looks forward to working with the offices of Sens Kirk and Johnson to advance the bill in Congress.
You are less than 2 weeks away from what could be the next level in your career-find out at APTA's free Virtual Career Fair on Thursday, June 6, 1:00 pm-4:00 pm ET. This live, online event is a great way for you to engage directly with employers about their current and future physical therapy opportunities. Participate in the Virtual Career Fair for as long as you wish, chatting 1-on-1 with recruiters to discuss your background and experience, and their current and future career opportunities. Here are a few of the companies you'll find at the Virtual Fair: Caduceus Occupational Medicine, Hallmark Rehabilitation, and Dynamic Physical Therapy. Space is limited, so register today.
APTA has reached out to the Oklahoma Chapter offering our condolences, assistance, and support following the devastating tornado this week. The chapter board has voted to designate funds toward relief efforts, with matching funds provided from APTA. Through its social media outlets and other channels, the chapter continues to reach out to identify those in the physical therapy community directly affected by the storms. At this time, a designated fund for relief efforts to directly benefit our community has not been established.
Members interested in contributing to relief efforts are encouraged to donate to the American Red Cross Disaster Relief Fund.
A blog post by APTA "Fit After 50 Member Challenge" winner Patsy Shropshire, PT, is the featured story on www.BoomerCafé.com. Shropshire talks about her health and wellness group for women who primarily are in their 50s and 60s. The group is called "Women With Balls," and most are cancer survivors. Read their story and post about it to your social sites!
Join the Foundation for Physical Therapy for a special evening at the Foundation Gala: Honoring Past and Present Visionaries on Thursday, June 27, at the Hilton Salt Lake City Center during APTA's Conference & Exposition.
The program will include recognition of the Foundation's 2013 service award recipients and a special tribute to past trustees of the Foundation's Board of Directors. The evening also will include a special celebration of the 25th anniversary of the Marquette Challenge.
Enjoy dinner, dancing, and the opportunity to bid on the following items in the Silent Auction: elegant vintage jewelry provided by Empire Diamond, an adventurous half-day sail aboard Stanley Paris' Kiwi Spirit, and an exquisite selection of handmade pottery by Roger Allen Clay.
If you have not already purchased a ticket, please do so by June 5. Regular admission is $150 ($100 for students). Table sponsorships are $2,000 and include 10 tickets plus additional benefits. Find out how to purchase tickets or call Erica Sadiq at 703/706-8595.
There are 7 million people in the United States who have survived a stroke, according to the National Stroke Association-and these survivors are your patients. Now, during National Stroke Awareness Month, help ensure their access to physical therapist services by e-mailing your legislators and asking them to repeal the Medicare therapy cap. Tell Congress that your patients-their constituents-must receive timely and proper care after they have suffered a stroke.
APTA has joined the American Speech-Language-Hearing Association (ASHA) and the American Occupational Therapy Association (AOTA) to highlight National Stroke Awareness month on Capitol Hill through this rolling e-mail campaign. The goal is not only to repeal the cap but to bring awareness to the importance of rehabilitation following a stroke.
Nonmembers and patients can also get involved and contact their legislators using APTA's Patient Action Center. Please take time to personalize your e-mails and share your experience as a physical therapist, physical therapist assistant, or patient. Members of Congress care how this issue impacts their constituents.
As summer approaches, this issue will heat up as Congress works on legislation to reform the Medicare physician fee schedule and the sustainable growth rate formula. It is more important than ever to let your members of Congress know that patients should not be subjected to an arbitrary cap on medically necessary services.
Join Mike Klonowski, PT, DPT, PCS, who has been treating Sen Mark Kirk (R-IL) following his stroke in 2012, and help ensure no one is denied necessary physical therapy by taking action today.
The global bodies for the 5 leading health professions, representing more than 26 million health professionals worldwide, are calling for a new emphasis on collaborative practice. Health professions working together around the world can lead to improved health services and a more effective use of resources, they say.
The World Health Professions Alliance (WHPA), which brings together the World Confederation for Physical Therapy, the International Council of Nurses, the International Pharmaceutical Federation, the World Dental Federation, and the World Medical Association, issued a statement during the World Health Organization's 66th World Health Assembly this week.
WHPA calls on governments to fund health system structures that support interprofessional collaborative practice, promote shared learning in education programs, and encourage health professionals to respect each others' expertise.
Marilyn Moffat, PT, DPT, PhD, DSc (hon), GCS, CSCS, CEEAA, FAPTA, president of the World Confederation for Physical Therapy said: "Effective interprofessional collaborative practice brings benefits in every area of health services-from health promotion through injury prevention to condition management. Working together, professionals can effectively address pressing societal health needs such as the growing burden of noncommunicable diseases and their risk factors."
Physical therapists and physical therapist assistants who want to better understand the health insurance exchange initiative that resulted from the Affordable Care Act, also being called the health insurance marketplace, can tune in to webinars from the Centers for Medicare and Medicaid Services (CMS).
Repeated several times throughout June and July, these training opportunities are broken into 2 levels:
Level 1: Health Insurance Marketplace 101. A 1-hour high-level overview of the accomplishments of the Affordable Care Act and a basic introduction to the marketplace (exchanges) highlighting who is eligible and how the marketplace will work.
Level 2: Understanding the Health Insurance Marketplace. A 2-hour detailed review of the marketplace (exchanges), including eligibility, enrollment, plan structure, Medicaid expansion, and the streamlined application.
The training sessions are free but first-come-first-served, with a limit of 200 people per session. CMS said, however, that it will add sessions if there's high demand.
Due to necessary upgrades of the content management system powering APTA.org and other APTA websites, there will be no new content posted at these sites effective immediately until the system upgrades are complete.
During this time, you can still access content, login to your account, and perform usual transactions (course registrations, profile changes, etc), but APTA will not be able to make content updates to sites, including the posting of breaking news.
The "content freeze" could last as few as 48 hours, but it also could end as late as Friday, May 24.
Affected sites are:
We regret the inconvenience and thank you for your patience.
Contact APTA's member services department if you experience any problems on these sites during the upgrade period.
To help clinicians meet the July 1 functional limitation reporting requirements, PTNow is providing appropriate tests and measures for member use. The tests and measures were identified by APTA section teams and EDGE task forces for the highest-volume conditions in their content areas.
Because many of these tests are copyrighted, APTA is securing licenses to offer them via PTNow and will post links to the usable tests as they become available. (New tests are added almost daily.)
The tests are grouped by clinical focus and condition, and tests are listed alphabetically within groups. In the coming weeks the tests will be organized and searchable by functional limitation category (Mobility: Walking & Moving Around, Changing & Maintaining Body Position, Carrying, Moving, & Handling Objects, Self-Care, Other PT/OT Subsequent Functional Limitation).
Physical therapists from disadvantaged backgrounds can apply for up to $40,000 in student loan assistance through the Health Resources and Services Administration (HRSA) Faculty Loan Repayment Program (FLRP). Applications now are being accepted for the program, which offers health professions faculty, including physical therapists, the opportunity to pay off qualified student loans. FLRP is designed to increase the recruitment and retention of health professions faculty with the goal of preparing the next generation of health care professionals. In return for loan assistance, accepted applicants will provide 2 years of service at an approved health professions institution.
Deadline for applications is June 27, 2013. For more information or to apply, visit the FLRP website.
APTA continues its public policy priority to include physical therapists in additional student loan repayment initiatives.
APTA's popular Business Skills in Physical Therapy: Strategic Marketing home-study course is now in its second edition, with the latest strategies—along with the tried-and-true guidance from the first edition—that will help every practice, large or small, capture the opportunities to build and maintain a strong customer base in today's vibrant, yet challenging, health care marketplace.
See what's new from author Peter R. Kovacek, PT, DPT, MSA, founder of PTManager.com:
Strategic Marketing includes case studies, the marketing readiness assessment tool, and an outline for developing a full marketing plan.
There are only a few days left to save 20% on all apparel and specialty items at the APTA Marketplace. Now is the time to save on those gifts and giveaways you've been meaning to purchase. Shop today at www.apta.org/Marketplace.
Nearly $1 billion will be available to fund the second round of the Health Care Innovation Awards, which encourage programs that drive health care system transformation and deliver better outcomes. Last year, the Centers for Medicare and Medicaid Services (CMS) awarded 107 round one Health Care Innovation Awards out of nearly 3,000 applications to organizations that are testing innovative solutions to improve outcomes and reduce costs. Projects are located in urban and rural areas, all 50 states, the District of Columbia, and Puerto Rico.
In this round, CMS is specifically seeking innovations in 4 areas: rapidly reducing costs for patients with Medicare and Medicaid in outpatient hospital and other settings; improving care for populations with specialized needs; testing improved financial and clinical models for specific types of providers, including specialists; and linking clinical care delivery to preventive and population health.
"We see innovative solutions in delivering and improving care deployed all over the country," said Marilyn Tavenner, who yesterday was confirmed as CMS administrator after being the acting administrator since late 2010. "Over the last 3 years, we have seen national health care cost growth slow significantly, and we want to continue that trend by … testing new models of paying for quality care. These awards will help spur private and public sector innovation in this endeavor."
As physical therapists and other health care providers know all too well, people with terminal illnesses and their caregivers often are confused and conflicted over how to make good decisions, which affects their quality of life, health care costs, and family stress levels. The Hastings Center has updated and expanded its landmark 1987 consensus guidelines for ethical care of terminally ill patients, incorporating innovations and research over the past 26 years.
New or revised topics in the updated edition include issues specific to patients with disabilities; decision-making for and about children near the end of life; recent evidence regarding brain injuries and neurological states; palliative sedation; and the role cost plays as an ethical issue in health care decision-making.
Health and Human Services (HHS) released National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care, which includes 15 standards developed by its Office of Minority Health to expand health equity, improve quality, and address health care disparities in diverse and minority communities. The standards help organizations tailor culturally and linguistically appropriate health care services to an individual's culture and language preferences to improve health care outcomes.
HHS federal and nonfederal partners provided input to create the new standards, which are an enhanced version of the 2000 National Culturally and Linguistically Appropriate Services Standards.
Deputy Assistant Secretary for Minority Health and Director of the HHS Office of Minority Health J. Nadine Gracia, MD, MSCE, said, "As our nation becomes increasingly diverse, improving cultural and linguistic competency across public health and our health care system can be one of our most powerful levers for advancing health equity."
You can view a map of states that have proposed or passed CLAS legislation here.
Fit to a T, the US Bone & Joint Initiative's (USBJI) free public education program on bone health and osteoporosis, reached a milestone last week with the presentation of its 500th session. APTA is a founding member of USBJI.
The event took place at the Catonsville Senior Center in Catonsville, Maryland. APTA member Laxmi Suryanarayana, PT, presented the session.
"We developed Fit to a T as a sustainable public education program, in response to the Surgeon General's Report on Bone Health and Osteoporosis. Bone health has a significant impact on overall health for everyone, regardless of race or whether you are male or female. Participants in the program learn how to maintain their bone health and how to identify their own risk factors for bone loss and osteoporosis. Being able to celebrate the 500th session demonstrates the continued public interest in this topic," said Kimberly Templeton, MD, USBJI president and chair of the USBJI Fit to a T Task Force.
Relevant to all ages, Fit to a T is targeted at men and women in their mid-40s to late 60s, as well as seniors and others who have or are at risk of having a broken bone. To schedule a session in your community, contact Shari Maier, USBJI program coordinator, 847/430-5054 or firstname.lastname@example.org.
Robin Anthony McKenzie passed away at his home at Raumati Beach, New Zealand, at the age of 82, on Monday, May 13 after battling with cancer for several months. McKenzie established the internationally recognized McKenzie Method of Mechanical Diagnosis and Therapy (MDT) and in 1982 founded the McKenzie Institute International.
McKenzie developed a special interest in treating spinal disorders after opening a private practice in Wellington, New Zealand, after graduating in 1952 from the New Zealand School of Physiotherapy.
APTA named him an honorary member "in recognition of distinguished and meritorious service to the art and science of physical therapy and to the welfare of mankind."
The McKenzie Institute has published a full obituary and established a tribute page at www.mckenziemdt.org, where visitors are welcome to express condolences to his family and to share memories.
Physical therapists and other health care providers that contract with Medicare Advantage plans should check their agreements to make sure their payments aren't erroneously being cut by 2% as part of sequestration. CMS clarified in a May 1 memo to Medicare Advantage organizations and others that sequestration does not mandate a 2% reduction of reimbursement to Medicare Advantage plan contracted providers. Medicare Advantage plans themselves are subject to the 2% reductions; however, Medicare Advantage plans cannot pass along sequestration cuts to providers unless their contracts with specific providers permit the pass-through. If providers determine that their contracts don't permit these cuts, they should consider challenging the reductions as contrary to their participation and network agreements.
Two studies recently published in the journal Health Affairs counter an earlier Kaiser Foundation report that had credited the sluggish economy for much of the slowdown in the growth of health care spending. While the newer studies offer a higher possibility that health care reform is behind at least some of the slow growth, they don't specifically say so.
The first study, concluded that the 2007-2009 recession accounted for 37% of the slowdown between 2003 and 2012, with another 8% attributed to a decline in private insurance coverage—leaving 55% unaccounted for. The authors concluded that the rest was the result of "a host of fundamental changes—less rapid development of imaging technology and new pharmaceuticals, increased patient cost sharing, and greater provider efficiency."
If they're right, and the trends continue 2013-2022, they said, public sector health care spending could be as much as $770 billion less than predicted.
In the second study, the authors analyzed 150 large employers covering some 10 million enrollees during the time period 2007-2011. They observed a slowdown in spending both when benefit design changes made the employer plans "less generous" and when benefit design was held "generally constant," concluding that "other factors, such as a reduction in the rate of introduction of new technology, were also at work," suggesting that the slowdown may persist as a result of greater efficiencies.
New Oregon legislation eliminates the 60-day time restriction tied to treatment for services provided by a physical therapist without a physician referral, granting unrestricted patient access to the services of a physical therapist. Oregon Gov John Kitzhaber signed House Bill 2684 into law yesterday.
"This is a significant achievement for Oregon, and we are pleased to see it happen," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "This law removes an arbitrary time limit that was an unwarranted and unnecessary barrier to the continuum of treatment by a physical therapist."
"Oregon has a proud tradition of pioneering change in health care, which was recently demonstrated through 2 large projects that steer patients directly to a physical therapist for treatment of low back pain," said Chris Murphy, PT, president of the Oregon Physical Therapy Association (OPTA). "Removal of the unnecessary restriction on access to a physical therapist is a welcome improvement for our patients and aligns perfectly with the goals of health care reform to foster improved collaborative care with each professional working at the top of his or her scope of practice."
Patient direct access, for which OPTA vigorously advocated, initially was introduced in the state in 1993. This was a win for OPTA and the profession, but the original law imposed a 30-day time limit for treatment without a physician referral. In 2007, the Oregon Chapter again achieved success, with legislation that extended the time limit from 30 to 60 days. HB 2684 completely removed restrictions that prevented patients from receiving unhindered treatment from a physical therapist. The legislation will take effect on January 1, 2014.
The Nominating Committee Candidate Interview Videos are up and ready for your viewing. The videos are posted online at APTA's Elections & Nominations 2013 Slate of Candidates webpage. Please make time to watch all 4 videos, approximately 15 minutes in length. Delegates are electing 2 Nominating Committee members during the 2013 House of Delegates in June.
The use of a foot drop stimulator (FDS) or an ankle foot orthosis (AFO) coupled with initial physical therapy sessions significantly improves gait speed in stroke survivors, say authors of a study published electronically ahead of print in May in the journal Stroke.
The authors, from the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, conducted a multicenter, randomized, single-blind trial comparing FDS and AFO treatments for stroke survivors with gait speeds ≤0.8 m/s. Study participants consisted of 118 males and 79 females, aged 61-72 who experienced a stroke 4-5 years prior to the trial. Participants were treated using FDS or AFO for 30 weeks and provided 8 physical therapy sessions during the first 6 weeks of the trial.
The authors found significant improvements in gait speed using either FDS or AFO, with a mean change of 0.14 m/s for FDS and 0.15 m/s for AFO. When comparing FDS and AFO treatment groups, they did not find much variance in gait speed between the groups, but concluded that the FDS group expressed significantly greater user satisfaction than the control group. They also found significant improvements in standard measures of body structure and function, activity, and participation in both the FDS and AFO treatment groups and concluded that their "clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke."
Read The Successful Physical Therapist to explore the brand behaviors outlined in the e-book. Then, take the short quiz at the end and provide your name and e-mail address to be eligible to win an iPad Mini! But hurry—time is running out—the drawing is Tuesday, May 21, 2013!
Although 57% of the largest US physician societies explicitly consider costs when creating clinical guidelines, vague cost integration approaches persist in many societies, say authors of a study published electronically ahead of print in May in JAMA Internal Medicine.
For this study, the authors analyzed the publically available methodology statements and clinical guidelines produced by the 30 largest US physician societies between 2008 and 2012. The authors examined "whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations."
Among the 30 societies examined, 17 (57%) explicitly integrated cost considerations, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) did not discuss costs, concluded study authors. Additionally, among the 17 societies that explicitly integrated cost considerations, 8 (47%) did not do so consistently nor did they discuss specific cost consideration mechanisms.
The authors indicated that the findings are significant for health care providers because recommendations for these societies could play a role in the reimbursement policies of organizations such as the Centers for Medicare and Medicaid Services.
Last year, APTA hosted a workshop for sections on developing clinical practice guidelines, where both costs of implementing recommendations and cost savings from following the guidelines were discussed. A similar workshop is scheduled for July this year.
APTA has announced that ReDoc Software (ReDoc), a documentation and management software provider for outpatient rehabilitation services, has been named a Strategic Business Partner of APTA. Through its Strategic Business Partners Program, APTA seeks to enhance business relationships and develop meaningful partnerships with for-profit companies by offering services and marketing opportunities that provide mutual benefits to partners and APTA.
With 2 new appointments last week, physical therapists are well represented on the National Institutes of Health (NIH) National Advisory Board on Medical Rehabilitation Research. Pamela W. Duncan, PT, PhD, FAPTA, is completing a 3-year term on the board and has served as chair for the past year. Richard K. Shields, PT, PhD, FAPTA, is completing his first year on the board and recently was elected chair for the 2014-2015 term. And last week, during the board’s May 2 meeting, Anthony Delitto, PT, PhD, FAPTA, and Fay M. Horak, PT, PhD, were appointed to serve 3-year terms as members.
The National Advisory Board Medical Rehabilitation and Research advises the directors of NIH, the National Institute of Child Health and Human Development, and the National Center for Medical Rehabilitation Research on matters and policies relating to the Center's programs. The board comprises 12 members representing health and scientific disciplines related to medical rehabilitation and 6 members representing individuals with disabilities.
The Foundation for Physical Therapy now is accepting applications for the 2013 Florence P. Kendall Doctoral Scholarships and the 2013 research grants. The deadline for all applications is Wednesday, August 14, 2013, noon ET.
The $5,000 Kendall Doctoral Scholarships, part of the Foundation's Doctoral Opportunities for Clinicians and Scholars (DOCS) program, help physical therapists and physical therapist assistants within their first year of postprofessional doctoral degree studies.
The available 2013 research grants include the Foundation Research Grant, Magistro Family Foundation Grant, and Pediatric Research Grant.
If you have questions about either program, e-mail the Foundation, or call 800/875-1378.
Do you want serve on a committee that provides leadership and growth opportunities, while providing a flexible time commitment? Consider volunteering for an Awards Committee subcommittee. APTA's Awards Committee is seeking members wishing to use their experience and knowledge to honor those in the physical therapy profession who are worthy of recognition. Interested members should respond to the call by completing a volunteer interest profile found on the Volunteer Interest Pool webpage. Once your profile is complete, click on the Current Volunteer Opportunities button to browse the list of opportunities. The deadline to respond to this call is May 20. For more information on this committee, click on the link above or contact Stephanie Sadowski, Honors and Awards Program specialist.
Guidance issued by the Centers for Medicare and Medicaid Services (CMS) clarifies that in 2013 physical therapists (PTs) must issue a valid Advanced Beneficiary Notice (ABN) to patients to collect out-of-pocket payment from Medicare beneficiaries when Medicare deems services "not reasonable and necessary" after the therapy cap is exceeded.
CMS added a frequently asked questions (FAQ) document to its therapy resources page that describes in further detail the rules for using an ABN for services that exceed the therapy cap on or after January 1, 2013, as a result of the Taxpayer Relief Act of 2012. The FAQ reinforces that "If the ABN isn't issued when it is required and Medicare doesn't pay the claim, the provider/supplier will be liable for the charges."
This is a significant change in Medicare policy regarding the use of the ABN when the therapy cap is exceeded. Before 2013, the provider was not required to provide the beneficiary with an ABN when the therapy cap is exceeded for the beneficiary to be liable for denied charges.
The FAQ clarifies that a PT must issue a valid ABN to the beneficiary before providing services when the PT believes that Medicare will deny a service because it is "not reasonable and necessary," such as when the patient has exceeded the therapy cap and continued services don't qualify under the exceptions process. CMS further clarifies that PTs must not issue the ABN to all beneficiaries who receive services that exceed the cap amount, only to those whose services the PT believes do not meet the Medicare definition of "reasonable or necessary." If the PT submits a claim with the KX modifier for an exception to the therapy cap, he or she is attesting that the services are reasonable and necessary.
PTs with further questions on using ABNs can contact CMS at RevisedABN_ODF@cms.hhs.gov.
The Centers for Medicare and Medicaid Services' (CMS) proposed inpatient rehabilitation facility (IRF) prospective payment system (PPS) rule for fiscal year 2014 includes a 2% increase. The increase is based on a marketbasket update to payments of 1.8% and a 0.2% increase to the outlier threshold. CMS estimates the fiscal impact to be $150 million.
The proposed rule, issued May 2, would further restrict which facilities qualify for the higher IRF PPS rates, as opposed to the lower the hospital inpatient PPS rates. To qualify, an inpatient hospital must demonstrate that at least 60 percent of its patients meet the criteria specified in the regulations, including the need for intensive inpatient rehabilitation services for 1 or more of 13 listed conditions that presume the need for intensive inpatient rehabilitation. CMS proposes to drop several diagnostic codes from the "presumptive compliance" list, saying these conditions "would not prove compliance in the absence of additional facts that would have to be pulled from a patient's medical record."
Elsewhere in the proposed ruling, CMS plans to continue to use the catheter-associated urinary tract infection (CAUTI) outcome measure endorsed by NQF, which recently was updated from a non-endorsed measure; and to adopt a risk-adjusted pressure ulcer measure, dropping a non-risk adjusted version. In addition, CMS proposes to add 3 new quality measures to the IRF Quality Reporting Program, 2 related to flu vaccine and 1 to readmissions.
CMS will accept comments regarding the provisions of the proposed rule until July 1, 2013. APTA will provide a comprehensive summary of the proposed rule in the coming days and will submit comments on behalf of the membership.
Finnish researchers reported that an intensive, long-term exercise program was beneficial to the physical functioning of patients with Alzheimer disease (AD) without increasing total costs of health and social services or causing any significant adverse effects. The implications are promising, if increased, targeted exercise would allow more patients to remain at home or delay a move to a care facility.
The study included 210 home-dwelling patients with AD living with their spousal caregivers, divided into 3 groups: group-based exercise, tailored home-based exercise, and "usual community care." Both exercise groups were led by physical therapists who tailored the exercise to the patients' needs. The group-based exercise group attended twice-a-week classes, while a physical therapist visited the home-based group for 1 hour twice a week.
After 1 year, the home-exercise and group-exercise subjects had significantly less deterioration in function and significantly fewer falls than the control subjects, with the home-exercise group faring the best. The main outcome measures used included the Functional Independence Measure, Short Physical Performance Battery, and information on the use and costs of social and health care services.
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule yesterday that outlines Fiscal Year (FY) 2014 updates for Skilled Nursing Facility (SNF) prospective payment system (PPS) payment rates. The updates included a 1.4% estimated SNF market basket update to FY 2014 payments, with CMS estimating a $500 million increase in FY 2014 aggregate payments. CMS also noted that providers were not negatively impacted by FY 2012 allocation of group therapy minutes and implementation of the change of therapy.
Additionally, the proposed rule would add items 00420 (Calendar Days of Therapy) to the Minimum Data Set and clarify that "classification criteria for the Rehabilitation RUG categories require that the resident receive the requisite number of distinct calendar days of therapy to be classified into the Rehabilitation RUG category." RUG stands for resource utilization group. The RUG level, which is based on facility needs, nursing care, and therapy minutes provided per week, determines the amount of money per day that Medicare will pay for a patient's stay at a facility.
The proposed rule would also invite suggestions to identify alternatives to current methods used to pay for therapy services under the SNF PPS, and require SNFs, beginning October 1, 2013, to record the number of distinct calendar days of therapy provided by all rehabilitation disciplines over the 7-day look-back period for the current assessment.
CMS will accept comments on provisions of the proposed rule until July 1, 2013. APTA will provide a comprehensive summary of the proposed rule in the next few days and will submit comments on behalf of the membership.
The New England Journal of Medicine (NEJM) study showing physical therapy to be as effective as surgery for some patients with meniscal tears and osteoarthritis (OA) of the knee was the topic of conversation in today's episode of Move Forward Radio.
Clare Safran-Norton, PT, PhD, MS, OCS, who participated in the MeTeOR Trial (Meniscal Tear in Osteoarthritis: A Random Controlled Trial), discussed the study, which showed no significant differences in functional improvement after 6 months between patients who opted for surgery with postoperative physical therapy and those who received standardized physical therapy alone.
APTA promoted the episode and other supporting consumer resources such as the Physical Therapist's Guide to Meniscal Tear and the Physical Therapist's Guide to Osteoarthritis of the Knee via social media.
Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to email@example.com.
Attend APTA's online Virtual Career Fair on Thursday, June 6, 1:00 pm-4:00 pm ET. This live, online event is a great way for you to engage directly with employers about their current and future physical therapy opportunities.
Participate in the Virtual Career Fair for as long as you wish, chatting 1-on-1 with recruiters to discuss your background and experience, and their current and future career opportunities.
Space is limited, so register now.
To help health care providers comply with privacy and security requirements, and help consumers better understand their rights, new resources on the Health Insurance Portability and Accountability Act (HIPAA) are available online. The Department of Health and Human Services Office for Civil Rights (OCR) has developed fact sheets, continuing education modules, and videos, all of which are now linked from APTA's HIPAA webpage at www.apta.org/HIPAA under Related Resources.
New for providers are 3 video educational modules (hosted on Medscape.org, free login required) and a YouTube video that explains how to protect patient information in compliance with HIPAA security rules. For consumers, 7 new multilingual consumer fact sheets complement 7 videos released earlier this year on OCR/s YouTube channel.
Although emergency medical services (EMS) use can increase stroke evaluation and treatment, more than a third, or 36.3%, of stroke patients fail to use EMS to get to the hospital, say authors of a study published electronically ahead of print in April by the journal Circulation: Cardiovascular Quality and Outcomes.
For this study, the authors analyzed data from 204,591 hemorrhagic and ischemic stroke patients. Those patients were admitted to 1,563 hospitals that use National Institute of Health Stroke Score and insurance status data and participate in the Get With the Guidelines-Stroke program.
The authors concluded that while 63.7% of patients arrived to the hospital via EMS, older patients using Medicaid and Medicare insurance and severe stroke patients were more likely to use EMS services. Race and ethnic minorities and people living in rural areas were less likely to use EMS services. Use of EMS services is associated with earlier arrival, prompter evaluation, more rapid treatment, and greater eligibility for treatment with tissue-type plasminogen activator.
Members can view APTA's issue brief (member login required) on stroke to learn more about a physical therapist’s role in stroke prevention and treatment.
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